Lakhani Dr Karan R, Chaudhary Dr Sumedh, Gade Dr Shrikant, Sonkusale Dr Aashay
Department of Orthopaedics, Government Medical College and Hospital, Nagpur, Maharashtra, India.
Department of Orthopaedics, Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India.
J Clin Orthop Trauma. 2024 Nov 26;59:102842. doi: 10.1016/j.jcot.2024.102842. eCollection 2024 Dec.
Subtrochanteric fractures are subject to a variety of deforming forces that pose challenges to achieving an optimal reduction. This study aims to assess and highlight the advantages of treating these fractures with a long proximal femoral nail while in the lateral decubitus position.
This prospective study was carried out on 35 patients in our institute, managed with long proximal femoral nailing in lateral decubitus position. After surgery, the patients underwent functional and radiological evaluations one, three, and six months later.
Patients in the age group of 18-80 were operated on in this study. The mean age was 52.57, with 14 % [20/35] being males and 42.86 % [15/35] being females. 65 % [23/35] patients had a Russell Taylor type 1A fracture, 20 % [7/35] had 1B type, 8.6 % [3/35] had 2A type and 5.7 % [2/35] had 2B type. The average duration of the surgical procedures was 80 min. The average intraoperative blood loss was 105 ml. Intraoperative reduction assessment using the Modified Baumgartner classification showed 60 % [21/35] having a good reduction, 31.5 % [11/35] having an acceptable reduction, and 8.5 % [3/35] having poor reduction. Mean Harris Hip Score at the end of 6 months was 88 with 38.7 % [12/35] having excellent outcome, 41.9 % [13/35] having good outcome, 12.9 % [4/35] having fair outcome, 6.4 % [2/35] having poor outcome. The most common postoperative complication was shortening with 8.5 % [3/35].
The lateral decubitus position when by utilizing a long proximal femoral nail in subtrochanteric fractures has been demonstrated to facilitate easier identification of the entry point and provide easier access for reaming. This also reduced operative time while improving fracture reduction and subsequently radiological and functional outcomes.
转子下骨折会受到多种使骨折移位的力的影响，这给实现最佳复位带来了挑战。本研究旨在评估并强调在侧卧位使用股骨近端加长髓内钉治疗这些骨折的优势。
本前瞻性研究在我院对35例患者进行，采用侧卧位股骨近端加长髓内钉治疗。术后1个月、3个月和6个月对患者进行功能和影像学评估。
本研究纳入了年龄在18 - 80岁的患者。平均年龄为52.57岁，男性占14%（20/35），女性占42.86%（15/35）。65%（23/35）的患者为Russell Taylor 1A型骨折，20%（7/35）为1B型，8.6%（3/35）为2A型，5.7%（2/35）为2B型。手术平均时长为80分钟。术中平均失血量为105毫升。采用改良的鲍姆加特纳分类法进行术中复位评估，结果显示60%（21/35）复位良好，31.5%（11/35）复位可接受，8.5%（3/35）复位不佳。6个月时的平均Harris髋关节评分是88分，其中38.7%（12/35）疗效极佳，41.9%（13/35）疗效良好，12.9%（4/35）疗效一般，6.4%（2/35）疗效差。最常见的术后并发症是短缩，发生率为8.5%（3/35）。
在转子下骨折中采用侧卧位并使用股骨近端加长髓内钉已被证明有助于更轻松地确定进针点，并为扩髓提供更便利的操作空间。这还缩短了手术时间，同时改善了骨折复位情况以及后续的影像学和功能结果。
